-
Question 1
Incorrect
-
A 63 year old lady presents to ED with a persistent cough and red currant jelly sputum. She has a history of chronic alcohol abuse and has an X-ray which demonstrates a cavitating pneumonia. The most likely causative pathogen is:
Your Answer: Streptococcus pneumoniae
Correct Answer: Klebsiella pneumoniae
Explanation:One of the results of Klebsiella pneumoniae is pneumonia that is usually a very severe infection. It is characterised by thick, bloody sputum (red currant jelly sputum), and is associated with complications like lung abscess, cavitation, necrosis, empyema and pleural effusions.
-
This question is part of the following fields:
- Infections
- Microbiology
-
-
Question 2
Incorrect
-
You examine a 43-year-old woman who was referred to you by a friend. She suffers from a variety of medical conditions and takes a variety of medications, including amitriptyline.
Which of the following is NOT a contraindication to amitriptyline treatment?Your Answer: Heart block
Correct Answer: Breastfeeding
Explanation:Amitriptyline is a tricyclic antidepressant (TCA) that is most commonly used to treat depression, but it can also be used to treat anxiety disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD). It inhibits reuptake, raising serotonin and noradrenaline levels while also inhibiting acetylcholine action.
TCAs have a number of drawbacks, including:
Acute Porphyria
Arrhythmias
During bipolar disorder’s manic phase
Heart block
After a myocardial infarction, there is an immediate recovery period.TCA levels in breast milk are too low to be harmful, and use can be continued while breastfeeding.
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 3
Incorrect
-
A 71-year-old woman presents with complaints of fatigue and worsening muscle weakness, and blood tests done shows a potassium level of 2.4 mmol/L.
Which is NOT a recognised cause of hypokalaemia?
Your Answer: Bartter’s syndrome
Correct Answer: Type 4 renal tubular acidosis
Explanation:A plasma potassium less than 3.5 mmol/L defines hypokalaemia.
Excessive liquorice ingestion causes hypermineralocorticoidism and leads to hypokalaemia.
Gitelman’s syndrome causes metabolic alkalosis with hypokalaemia and hypomagnesaemia. It is an inherited defect of the distal convoluted tubules.
Bartter’s syndrome causes hypokalaemic alkalosis. It is a rare inherited defect in the ascending limb of the loop of Henle.
Type 1 and 2 renal tubular acidosis both cause hypokalaemia
Type 4 renal tubular acidosis causes hyperkalaemia.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 4
Correct
-
A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.
The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.
There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.
Which of these nerve(s) has most likely been affected?
Your Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:
Loss of sensation to the lateral palm and the lateral three and a half fingers.
Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.
Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis
Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles -
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 5
Incorrect
-
You have been asked to give a tutorial on common upper limb neurology to a group of medical students. You use the example of a man falling from a balcony onto spiked fencing, sustaining a puncture wound to the axilla. This results in an injury to the musculocutaneous nerve. Which of the following clinical features would you LEAST expect to see in this patient:
Your Answer: Weakness of forearm flexion
Correct Answer: Weakness of forearm pronation
Explanation:Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively. There is loss of sensation over the lateral aspect of the forearm. Forearm pronation would not be affected as this is primarily produced by the pronator quadratus and pronator teres muscles, innervated by the median nerve.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 6
Correct
-
Adrenocorticotropic hormone release from the anterior pituitary is stimulated by which of the following:
Your Answer: Corticotropin-releasing hormone
Explanation:ACTH secretion is stimulated by corticotropin-releasing hormone (CRH) from the hypothalamus.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 7
Incorrect
-
The functional residual capacity (FRC) will be increased in which of the following:
Your Answer: Pregnancy
Correct Answer: Emphysema
Explanation:Factors increasing FRC:
Emphysema
Air trapping in asthma
Ageing (due to loss of elastic properties)
Increasing height of patient -
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 8
Correct
-
A 50-year-old man from Russia presents with a history of cough with blood-stained sputum, fever, night sweats, and weight loss. Suspecting tuberculosis, you begin investigations.
All the following statements regarding tuberculosis (TB) are true EXCEPT?Your Answer: Corticosteroid use is not a risk factor for developing TB
Explanation:Immunosuppressants like corticosteroids may be an important risk factor for developing tuberculosis.
All of the other statements are true.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 9
Incorrect
-
A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.
She's most likely to have developed which of the following side effects?Your Answer: Diarrhoea
Correct Answer: Constipation
Explanation:Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.
When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.
-
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
-
-
Question 10
Incorrect
-
Regarding box and whisker plots, which of the following statements is true?
Your Answer: They are used to display qualitative variables
Correct Answer: 25% of the values lie below the lower quartile
Explanation:A box and whisker plot is defined as a graphical method of displaying variation in a set of data. In most cases, a histogram analysis provides a sufficient display, but a box and whisker plot can provide additional detail while allowing multiple sets of data to be displayed in the same graph.
The procedure to develop a box and whisker plot comes from the five statistics below:
(1) Minimum value: The smallest value in the data set
(2) Second quartile: The value below which the lower 25% of the data are contained
(3) Median value: The middle number in a range of numbers
(4) Third quartile: The value above which the upper 25% of the data are contained
(5) Maximum value: The largest value in the data set
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 11
Incorrect
-
The arterial blood gas (ABG) of a 56-year-old woman shows type A lactic acidosis.
What is the most likely cause of her lactic acidosis?
Your Answer: Liver failure
Correct Answer: Left ventricular failure
Explanation:Lactic acidosis is a common finding in critically ill patients and commonly associated with other serious underlying pathologies. It occurs when pH is <7.35 and lactate is >5 mmol/L. Anion gap is increased in lactic acidosis.
Acquired lactic acidosis is classified into two subtypes:
Type A: lactic acidosis due to tissue hypoxia and
Type B: due to non-hypoxic processes affecting the production and elimination of lactateSome causes of type A and type B lactic acidosis include:
Type A lactic acidosis
Left ventricular failure
Severe anaemia
Shock (including septic shock)
Asphyxia
Cardiac arrest
CO poisoning
Respiratory failure
Severe asthma and COPDType B lactic acidosis:
Regional hypoperfusion
Renal failure
Liver failure
Sepsis (non-hypoxic sepsis)
Thiamine deficiency
Alcoholic ketoacidosis
Diabetic ketoacidosis
Cyanide poisoning
Methanol poisoning
Biguanide poisoning -
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 12
Incorrect
-
Regarding the heart sounds in the cardiac cycle, which of the following statements is INCORRECT:
Your Answer: The fourth heart sound is heard in late diastole.
Correct Answer: The third heart sound is caused by filling of an abnormally stiff ventricle in atrial systole.
Explanation:Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
First heart sound – Start of systole – Caused by closure of the atrioventricular (mitral & tricuspid) valves
Second heart sound – End of systole – Caused by closure of the semilunar (aortic and pulmonary) valves
Third heart sound – Early diastole – Caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
Fourth heart sound – Late diastole – Caused by filling of an abnormally stiff ventricle in atrial systole -
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 13
Incorrect
-
A young patient presents with the features of an easily recognisable infectious disease.
Which of the following infectious diseases typically has an incubation period of less than 1 week? Select ONE answer only.Your Answer: Malaria
Correct Answer: Cholera
Explanation:Cholera has an incubation period of 12 hours to 6 days.
Other infectious disease that have an incubation period of less than 1 week include:
Staphylococcal enteritis (1-6 hours)
Salmonella enteritis (12-24 hours)
Botulism (18-36 hours)
Gas gangrene (6 hours to 4 days)
Scarlet fever (1-4 days)
Diphtheria (2-5 days)
Gonorrhoea (3-5 days)
Yellow fever (3-6 days)
Meningococcaemia (1-7 days)
Brucellosis has an incubation period of 7-21 days.
Measles has an incubation period of 14-18 days.
Falciparum malaria usually has an incubation period of 7-14 days. The other forms of malaria have a longer incubation period of 12-40 days.
Rubella has an incubation period of 14-21 days. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 14
Incorrect
-
On which of the following types of receptors does loperamide act?
Your Answer: Muscarinic receptors
Correct Answer: Opioid receptors
Explanation:Loperamide inhibits acetylcholine release from the myenteric plexus acts by action on opioid mu-receptors, and this then reduces bowel motility. The intestinal transit time is increased, thereby facilitating water reabsorption.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 15
Correct
-
An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:
No. of patients who took Ticagrelor: 300
No. of patients who took Ticagrelor and suffered a stroke: 30
No. of patients who took Warfarin: 500
No. of patients who took Warfarin and suffered a stroke: 20
Compute for the risk ratio of a stroke.Your Answer: 2.5
Explanation:Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.
RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).
RR = ART/ARC
RR = (30/300) / (20/500)
RR = 2.5Recall that:
If RR < 1, then the intervention reduces the risk of the outcome.
If RR = 1, then the treatment has no effect on the outcome.
If RR > 1, then the intervention increases the risk of the outcome. -
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 16
Incorrect
-
A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.
Which of the following biochemical profiles best supports this diagnosis?Your Answer: Hyponatraemic metabolic alkalosis
Correct Answer: Hypokalaemic metabolic alkalosis
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.
A typical biochemical profile can help establish a diagnosis of Cushing’s syndrome. The following are the primary characteristics:
Hypokalaemia
Alkalosis metabolique -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 17
Incorrect
-
Which of the following study designs is considered the most appropriate to safely determine whether an association exists between a well-established, commonly used, anti-hypertensive medication and causing type II diabetes mellitus?
Your Answer: A double-blind randomised controlled trial
Correct Answer: A meta-analysis
Explanation:Evidence-based medicine may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information. Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine.
Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 18
Incorrect
-
Which of the following is a primary action of calcitonin:
Your Answer: Inhibition of PTH secretion from the parathyroid glands
Correct Answer: Decreased bone resorption through inhibition of osteoclast activity
Explanation:Calcitonin is a 32 amino acid polypeptide that is primarily synthesised and released by the parafollicular cells (C-cells) of the thyroid gland in response to rising or high levels of plasma Ca2+ions. Its primary role is to reduce the plasma calcium concentration, therefore opposing the effects of parathyroid hormone.
Secretion of calcitonin is stimulated by:
– Increased plasma calcium concentration
– Gastrin
– Pentagastrin
– The main actions of calcitonin are:
– Inhibition of osteoclastic activity (decreasing calcium and phosphate resorption from bone)
– Stimulation of osteoblastic activity
– Decreases renal calcium reabsorption
– Decreases renal phosphate reabsorption -
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 19
Incorrect
-
The fluid in contact with a tube is dragged by frictional forces to the tube's sidewalls. This creates a velocity gradient in which the fluid flow is greatest in the tube's centre.
Which of the following terms most accurately characterizes this flow pattern?Your Answer: Irrotational flow
Correct Answer: Laminar flow
Explanation:The fluid in contact with a tube is dragged by frictional forces at the tube’s sidewalls. This creates a velocity gradient in which the fluid flow is greatest in the tube’s centre.
This is known as laminar flow, and it characterizes the flow in most circulatory and respiratory systems when they are at rest.The velocity of the fluid flow can fluctuate erratically at high velocities, particularly within big arteries and airways, disrupting laminar flow. As a result, resistance increases significantly.
This is known as turbulent flow, and symptoms include heart murmurs and asthmatic wheeze. -
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
-
-
Question 20
Incorrect
-
Regarding the abductor digiti minimi, which of the following statements is false?
Your Answer: It is an abductor of the fifth finger at the metacarpophalangeal joint
Correct Answer: It assists with flexion of the fifth finger at the middle phalanx
Explanation:Abductor digiti minimi is a short intrinsic muscle of the hand. It belongs to the group of muscles collectively called hypothenar muscles due to their acting on the 5th finger. Besides abductor digiti minimi, other hypothenar muscles include flexor digiti minimi brevis and opponens digiti minimi.
The main function of abductor digiti minimi involves abduction of the 5th finger, as well as flexion of its proximal phalanx. Along with other hypothenar muscles, this muscle forms the hypothenar eminence on the medial side of the palm.
Like other hypothenar muscles, abductor digiti minimi receives nervous supply from the deep branch of the ulnar nerve, derived from root values C8 and T1.
Abductor digiti minimi receives arterial blood supply from the palmar branch of ulnar artery, palmar digital artery, as well as branches of the ulnar side of the superficial palmar arch. The venous blood from the muscle is drained via the venous networks of the palm into the deep veins of the arm (vv. ulnares).
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 21
Incorrect
-
Depolarisation of a neuron begins with which of the following:
Your Answer: Closing of voltage-gated Na + channels
Correct Answer: Opening of ligand-gated Na + channels
Explanation:Action potentials are initiated in nerves by activation of ligand-gated Na+channels by neurotransmitters. Opening of these Na+channels results in a small influx of sodium and depolarisation of the negative resting membrane potential (-70 mV). If the stimulus is sufficiently strong, the resting membrane depolarises enough to reach threshold potential (generally around -55 mV), at which point an action potential can occur. Voltage-gated Na+channels open, causing further depolarisation and activating more voltage-gated Na+channels and there is a sudden and massive sodium influx, driving the cell membrane potential to about +40 mV.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 22
Incorrect
-
Stimulation of J receptors located on alveolar and bronchial walls results in all of the following EXCEPT for:
Your Answer: Relaxation of skeletal muscle
Correct Answer: Tachycardia
Explanation:Juxtapulmonary or ‘J’ receptors are located on alveolar and bronchial walls close to the capillaries. Their afferents are small unmyelinated C-fibres or myelinated nerves in the vagus nerve. Activation causes depression of somatic and visceral activity by producing apnoea or rapid shallow breathing, a fall in heart rate and blood pressure, laryngeal constriction and relaxation of skeletal muscles via spinal neurones. J receptors are stimulated by increased alveolar wall fluid, pulmonary congestion and oedema, microembolism and inflammatory mediators. J receptors are thought to be involved in the sensation of dyspnoea in lung disease.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 23
Correct
-
Dehydration causes a significant increase in the amount of this hormone?
Your Answer: Antidiuretic hormone
Explanation:Antidiuretic hormone induces the kidneys to release less water, resulting in reduced urine production.
In the case of dehydration, ADH levels rise, resulting in a considerable decrease in urine output as well as an increase in plasma protein, blood Hct, and serum osmolality.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 24
Incorrect
-
A blood test of a 7-year-old child with a 6-day history of bloody diarrhoea reveals a low platelet count, anaemia, and impaired kidney function. What bacteria is suspected of causing such a condition?
Your Answer: Salmonella enterica
Correct Answer: Escherichia coli
Explanation:Escherichia coli produces shiga toxin that causes diarrhoea, hemorrhagic colitis, and haemolytic uremic syndrome.
Haemolytic uremic syndrome is characterized by anaemia, thrombocytopenia, and acute renal failure. Transmission of E. coli is possible after consuming contaminated, undercooked drinks and foods. E. coli enters the body via the faecal-oral pathway.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 25
Incorrect
-
Which of the following side effects has limited the use of etomidate as an intravenous induction agent:
Your Answer: Profound hypotension
Correct Answer: Adrenocortical suppression
Explanation:Etomidate causes the least cardiovascular depression of the intravenous induction agents, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly unstable patient. However, more recently it has become less popular as a single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4 – 8 hours, and up to 24 hours in elderly and debilitated patients. Although no increase in mortality has been identified following a single dose during induction of anaesthesia, the use of etomidate has declined due to a perceived potential morbidity.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 26
Incorrect
-
Urine flow rate = 2 ml/min
Urine concentration of creatinine = 18 mg/ml
Plasma concentration of creatinine = 0.25 mg/ml
What is the estimated glomerular filtration rate (eGFR)?
Your Answer: 0.4 ml/min
Correct Answer: 144 ml/min
Explanation:GFR can be estimated by:
GFR = UCr x V / PCr
Where:
UCr = urine concentration of creatinine
PCr = plasma concentration of creatinine
V = rate of urine flowIn this case GFR = (18 x 2) / 0.25 = 144 ml/min
Note: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 27
Incorrect
-
Where on the body is the radial artery pulsation best palpated?
Your Answer: At the wrist just medial to the flexor carpi radialis tendon
Correct Answer: At the wrist just lateral to the flexor carpi radialis tendon
Explanation:The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 28
Correct
-
A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.
The action most effective at minimizing spread to other patients is?
Your Answer: Hand washing
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.
Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.
Wearing an apron and gloves, and isolation to a side room are important contact precautions. They are, however, ineffective if hand washing is neglected.
Although oral vancomycin is the first-line treatment for C. difficile associated diarrhoea, it will not limit patient to patient spread.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 29
Correct
-
Glomerular filtration rate can be calculated using any substance that:
Your Answer: is freely filtered and neither reabsorbed nor secreted by the nephron
Explanation:Clearance of a substance can provide an accurate estimate of the glomerular filtration rate (GFR) provided that the substance is:freely filterednot reabsorbed in the nephronnot secreted in the nephronnot synthesised or metabolised by the kidney
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 30
Correct
-
Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:
Your Answer: Calcium gluconate
Explanation:Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.
-
This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
